Ortho-Preferred

Amoxicillin/K+ & Clavulic acid/Augmentin


- See: penicillin family

- Discussion:
    - combination of clavulanic acid and amoxicillin (augmentin - 250 or 500 mg of amoxicillin plus 125 mg of clavulanic acid) provides oral preparation with
             enhanced activity against beta-lactamase- producing strains of Staph, Branhamella catarrhalis, H. influenza, N gonorrhoeae, and bacteroides;
    - oral administration of amoxicillin and clavulanic acid (every 8 hours) is effective for treatment of human-bite infections and animal-bite infections
              in which Pasturella multocida, streptococci, staphylococci, anaerobes, and Eikenella corrodens are potential etiologic agents;
    - for beta lactamase producing H. influenza, Staph aureus, E. coli, Klebsiella, Enterobacter sp.;
    - most beta-lactamase-producing strains of E. coli, Proteus mirabilis, and Klebsiella species will be susceptible only to concentrations of combination present in urine;

- Dosing:
    - adult dosing:
          - 250-500 mg as amoxicillin PO q8hr;
          - Extended release (XR) 1000 mg q 12; (see discussion - MedicineNet.com)
          - do not substitute two 250mg tab for one 500mg because an over dose of clavulic acid may occur;
          - note infections of lower respiratory tract: 500mg q8hr;
          - infections of ear, nose, throat, GU, skin, soft tissues: 250mg q8h for 7-10 days;
          - acute uncomplicated GC: 3gm PO (single dose) plus probenicid 1gm PO (single dose) and tetracycline 500mg PO qid for 7 days;
          - note prophylaxis of bacterial endocarditis: 3gm PO 1hr before procedure and 1.5gm PO 6hrs later;
    - pediatric dosing:
          - 20-40 mg/kg/24hrs PO q8hr x 10 days;
          - supplied in susp 125, 250 mg/5 cc;
    - dosing in renal insufficiency:
          - dose for 70 kg adult (gm/dosing interval in hours)
          - CrCl: >80: 0.25-0.5/8;
          - CrCl: 50-79: 0.25-0.5/8;
          - CrCl:30-49:0.25-0.5/8;
          - CrCl:10-29: 0.25-0.5/12;

- Cautions:
    - will interact w/:
          - allopurinol (increase frequency  of rash)
          - aminoglycosides, oral anticoagulants (increase PT);
          - Oral contraceptives (decrease effectiveness)



- References

- Pubmed Discussion

- Antibiotics as Part of the Management of Severe Acute Malnutrition





Original Text by Clifford R. Wheeless, III, MD.

Last updated by Clifford R. Wheeless, III, MD on Friday, February 8, 2013 8:08 pm